作者： Bakris G, Calhoun D, Egan B, Hellmann C, Dolker M, Kingma I; orlistat and resistant hypertension investigators.
【摘自】外周血管病杂志, 2002年20卷11期.
【摘要】
目的： 探究对于血压控制不佳的肥胖患者，奥利司他联合低热卡的减肥方式与单纯饮食控制的减肥方式相比能够更好地改善血压。
设计： 这是为期1年的前瞻性、随机双盲、安慰剂对照、多中心试验。比较奥利司他联合饮食控制与安慰剂联合饮食控制对于肥胖高血压患者的血压改善情况。参与者被随机分配到奥利司他组和安慰剂组；所有患者都接受不足600卡的饮食并且来自脂肪的热量不超过30％。记录体重、血压、血脂、空腹血糖和胰岛素水平。
主要观察指标： 奥利司他组患者减重效果更好（-5.4 ±6.4 对比 -2.7 ± 6.4 kg, P < 0.001）并且体重指数降低更大（-1.9 ± 2.3 对比 -0.9 ± 2.2 kg/m2，P < 0.001）。奥利司他治疗组患者相比安慰剂组达到目标减重（其定义为 ≥ 5％的体重（BW））的人数更多（46% 对比23％，p < 0.001）。奥利司他治疗组患者相比安慰剂组舒张压下降更大（-11.4 ± 8.3 对比 -9.2 ± 8.4 mmHg，P = 0.002）。奥利司他治疗组患者达到目标舒张压（BP）（定义为最终舒张压< 90 mmHg或降低至少10 mmHg）的人数比例更大（67% 对比53％，P <0.001）。奥利司他治疗组中显著减少了总胆固醇（P < 0.001）和低密度脂蛋白胆固醇（P = 0.001）且不减少高密度脂蛋白胆固醇（P < 0.005）。奥利司他治疗组患者达到降低30％心血管风险人数比例更大（36.1%与24.0％，P < 0.04）。
结论： 联合奥利司他的减肥方式相比单纯控制饮食的减肥方式能更有效地降低血压，并最终更大的降低了心血管疾病的风险。
[关键词] 超重、肥胖、高血压、脂肪酶抑制剂、奥利司他、减重、抗高血压药试验、心血管风险、血脂检查
【文献原文】
Orlistat improves blood pressure control in obese subjects with treated but inadequately controlled hypertension
Author: Bakris G, Calhoun D, Egan B, Hellmann C, Dolker M, Kingma I; orlistat and resistant hypertension investigators.
Author Affiliations: Rush University Hypertension/Clinical Research Center, Department of Preventive Medicine, Rush Presbyterian/St. Luke's Medical Center, Chicago, Illinois, USA.
Quote From： J Hypertens. 2002 Nov;20(11):2257-67.
【ABSTRACT】
OBJECTIVE：
To investigate the hypothesis that weight reduction with orlistat plus mild caloric restriction leads to better blood pressure control than diet alone in obese individuals with inadequately controlled hypertension. DESIGN This was a 1-year, prospective, randomized, double-blind, placebo-controlled, multicenter trial of orlistat plus diet versus placebo plus diet in obese hypertensives.
INTERVENTIONS:
Participants were randomized to receive either orlistat or placebo; all received a 600 kcal deficient diet with no more than 30% of calories from fat. Weight and blood pressure, lipid levels and fasting glucose and insulin levels were followed.
MAIN OUTCOME MEASURES:
Patients on orlistat experienced greater weight loss (-5.4 +/- 6.4 versus -2.7 +/- 6.4 kg, P< 0.001) and greater reduction in body mass index (-1.9 +/- 2.3 versus -0.9 +/- 2.2 kg/m2, P<0.001). Target weight loss, defined as > or= 5% body weight (BW), was obtained in more orlistat-treated patients than in the placebo group (46 versus 23%, P<0.001). Diastolic BP decreased more in orlistat-treatedpatients than in the placebo group (-11.4 +/- 8.3 versus -9.2 +/- 8.4 mmHg, P = 0.002). A greater percentage of orlistat-treated patients reached goal diastolic blood pressure (BP), defined as final diastolic BP< 90 mmHg or a reduction of at least 10 mmHg (67 versus 53%, P< 0.001). The orlistat-treated group had significantly greater reductions in total cholesterol ( P<0.001), low-density lipoprotein cholesterol (P = 0.001) and non-high-density lipoprotein cholesterol (P< 0.005) and target 30% cardiovascular risk reduction was obtained in more orlistat-treated patients (36.1 versus 24.0%, P< 0.04).
CONCLUSION:
A weight-loss program with orlistat is more effective than diet alone to lower blood pressure and results in greater cardiovascular risk reduction.
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